Aboubakr Elnashar

1. THE ROLE OF COUNSELLING IN THE
MANAGEMENT OF INFERTILITY
Prof. Aboubakr Elnashar
Benha University Hospital, Egypt
ABOUBAKR ELNASHAR

2. Infertility counselling
1.What is psychological impact of infertility?
2.What is counseling?
3.How to increase rate of infertility counselling?
4.Mention 3 purposes of infertility counselling?
5.What are types of infertility counselling?
6.What are important indications of implication
counselling?
7.What are methods of offering support counseling?
8.What are the infertility counseller qualificaions in UK?
ABOUBAKR ELNASHAR

3. CONTENTS
I. PSYCHOSOCIAL & SOCIAL IMPACT OF
INFERTILITY
I. INFERTILITY COUNSELLING
II. ROLE INFERTILITY COUNSELLING
III. TYPES OF INFERTILITY COUNSELLING
IV. PROFESSIONAL QUALIFICATIONS AND
TRAINING
 CONCLUSION
ABOUBAKR ELNASHAR

4. I. PSYCHOSOCIAL & SOCIAL IMPACT OF
INFERTILITY
 Infertility
 Not only psychological but also a social impact
 Damage
 person’s sense of security
 confidence in the future.
 Life crisis
 Painful psychological trauma
ABOUBAKR ELNASHAR

5.  ART:
 can be alarming, traumatising .
 provoke many issues
 Emotional
 Cultural
 Moral
 Ethical for the patient.
ABOUBAKR ELNASHAR

6.  The psychological and social stress of infertility and
ART
 depression
 anxiety
 sexual dysfunction
 damaged self-esteem
 difficulties in interpersonal relationships.
ABOUBAKR ELNASHAR

7.  Detrimental implications of infertility. British Infertility
Counseling Association (BICA, 2012)
1. Infertility
 on relationships ‘with wife or husband, and
relatives and friends
 hard to deal with other people
 announcing a pregnancy
 having a baby or
 just seeing people enjoying family life.
 Women report significantly greater infertility
related anxieties than men
 life satisfaction
 sexuality
 self-blame
 self-esteem
 avoidance of friends.ABOUBAKR ELNASHAR

8. 2. Management of treatment
 elevated anxiety
3. Unsuccessful treatment:
 Lasting state of sadness.
 Negative emotions
 Anxiety
 Depression
 Distress
ABOUBAKR ELNASHAR

9.  The emotional impact of infertility
 Neglected
 The issue is reduced to
 biological or
 medical one.?!!!
ABOUBAKR ELNASHAR

10. II. INFERTILITY COUNSELLING
 What is counseling?
 Professional assistance to someone who seeks
help to overcome problem.
 Professional process=
 informed by a body of theoretical knowledge
 based on agreed codes of ethics and values.
(BICA, 2012)
 It is more than the use of counseling skills
 ±include the offer of information
 does not involve
 giving advice or
 directing a client to take a particular course of
action.
ABOUBAKR ELNASHAR

11.  Takes place
 By a counsellor
 In a private and confidential setting
 To:
 explore any
 difficulty
 distress or
 dissatisfaction with life
 increase a client ’ s ability to
 make choices and
 change aspects of their situation.
ABOUBAKR ELNASHAR

12.  Infertility counseling
 Since the 1980s, has gained increasing
recognition in a number of countries.
 20%
(Joy et al, 2015)
 Patients have relied primarily on their
 spouse and
 family when distressed, rather than on more formal support
resources.
 Why?
 less distressed patients: using their existing
resources
 more distressed patients failing:
 not knowing how to do so
 cost implications.ABOUBAKR ELNASHAR

13.  Higher
 higher levels of education
 middle and upper classes
 80% if
 counselling is an integral part of fertility TT
 its goals and course are made transparent
before it starts
ABOUBAKR ELNASHAR

14.  Infertility counselling (NICE, 2013)
 should be offered
1. before, during and after investigation and
treatment, irrespective of the outcome of these
procedures.
2. by someone who is not directly involved in the
management of the individual's and/or couple's
fertility problems.
3. Infertile couples should be
 seen together
{both are affected by decisions surrounding investigation and
treatment}.
 informed that they may find it helpful to
contact a fertility support group.
ABOUBAKR ELNASHAR

15. III. THE ROLE OF INFERTILITY COUNSELLING
 HFEA, 1990 (Human Fertility Embryology Association)
 Infertility counselling service
 Important
 Legal requirement in licensed ART clinics.
ABOUBAKR ELNASHAR

16.  The purpose of infertility counselling
 BICA, 2012
1. offers
1. patients an opportunity to explore their
thoughts, feelings, beliefs and relationships
2. support to them as they undergo treatment
2. help them to accommodate feelings about the
outcome of any treatment
3. within a non-judgemental, empathic framework,
clients are encouraged to find their own solutions.
ABOUBAKR ELNASHAR

17.  ESHRE, 2002
1. facilitates
1. Decision making regarding the continuation or
termination of treatment
2. discussion of alternatives to parenthood
• adoption or fostering or
• living a fulfilling life without children
2. informs individuals and couples regarding
 psychological
 social and
 legal implications of donor treatments
ABOUBAKR ELNASHAR

18. 3. offers
 support to help manage the psychological distress
of infertility before, during or after treatment
 therapeutic support to address the fertility problem
4. counsellor is also the arbiter of ethical behaviour.
‫الحكم‬
ABOUBAKR ELNASHAR

19. IV. TYPES OF INFERTILITY COUNSELLING
 4 types
 Not separate and linear but typically overlap.
1. INFORMATION COUNSELLING-
2. IMPLICATIONS COUNSELLING
3. SUPPORT COUNSELLING
4. POST THERAPEUTIC COUNSELLING
ABOUBAKR ELNASHAR

20. Peterson et al, 2012
ABOUBAKR ELNASHAR

21. 1. INFORMATION COUNSELLING
 Primary information given to the couple by the
infertility specialists may cause tension to few
couples.
 Unexplained fear may be seen at the initial stage of
TT.
 These patients need
 reassurance
 more explanation from the counsellor.
 This will help them to restore their confidence and
self- reliance.
ABOUBAKR ELNASHAR

22. 2. IMPLICATIONS COUNSELLING
 Decision making counselling
 In order to
 understand fully
 what it means to them and
 how it may affect them
 consequences of treatment decisions, including
termination,
 Especially recommended for
 Donor-assisted conception
 Surrogacy
 Those wishing to donate eggs, sperm or embryos
 Addresses legal, social and ethical issues of donor-
assisted conception.
ABOUBAKR ELNASHAR

23. 1. Fertility Preservation
1. Oncology Sperm Preservation
 Counselling
 Great sensitivity is needed
 it may not be appropriate to explore many of
the longer-term issues in a first session but,
wherever possible
 Counsellors
 should be aware of the very considerable
stress that they are likely to be experiencing
as a result of dealing with both life and
fertility threatening issues.
ABOUBAKR ELNASHAR

24. 2. Oncology Egg Preservation
 counselling about the implications of this treatment
before making any final decision.
 Great sensitivity is needed and it may not be
appropriate to explore many of the longer term
issues in a first session but, wherever possible,
 counsellors
 should be aware of the very considerable stress
that they are likely to be experiencing as a
result of dealing with both life and fertility
threatening issues.
ABOUBAKR ELNASHAR

25. 3. Oncology embryo storage
 Counselling about the implications of embryo creation and
storage before making any final decision.
 counsellors should be aware of the very considerable stress
that they are likely to be experiencing as a result of dealing
with both life and fertility threatening issues.
 Great sensitivity is needed and it may not be appropriate to
explore many of the longer-term issues in a first session but,
wherever possible
 counsellors should support and encourage them to consider
the same issues as those listed for oncology egg
preservation.
 It is also possible that their relationship may end before their
intended use of the embryos and counsellors should enable
clients to address this and the options open to them, advise
them of the current legal situation as well as offer further
counselling and mediation where appropriate.ABOUBAKR ELNASHAR

26. 4.Social Egg Preservation
 egg freezing by women who may not be in a
secure relationship and choose to store eggs for
when, and if, the right man comes along
 should cover a range of specified psychosocial
issues, including place of fertility in her life,
possible future treatment failure and the eventual
disposal of unused stored eggs.
ABOUBAKR ELNASHAR

27.  BICA guidelines
 encouraging focus on emotional and physical issues,
including
 the need to preserve sperm/eggs
 the urgency of this
 the reactions of the patient’s partner and other
relevant social contacts,
 options of ART open to them in the future
 potential of their failure
 possible disposal of preserved sperm
 legal implications and the possibility of cancer
reoccurrence after a potential child is born.
ABOUBAKR ELNASHAR

28. 2. Gamete/embryo donation
There are many psychosocial and legal implications for all
people involved in the potential creation of a family where
donated gametes or embryos are used. For instance, donors
need to consider their reasons for donating, the risks involved,
their rights and legal status regarding any potential children.
Recipients need to consider acceptance of their need for
donation, the potential impact of this disclosure on others,
legal parenthood and parental responsibility, informing the
potential child of its origin and the rights of all concerned and
the Donor Sibling Link (a register to connect donor siblings).
Critically, counsellors need to remind all donors and recipients
of the HFE Act, detailing that partners can be the legal parent
of any child
ABOUBAKR ELNASHAR

29. 3. SUPPORT COUNSELLING
 To overcome the emotional problems of the couples.
 before, during or after treatment, particularly to those
experiencing stress, ambivalence or distress.‫ازدواجيه‬
 Especially useful.
 Diagnosis of fertility problems
 Waiting for results
 Negative treatment outcomes
 Coming to terms with no further treatment
 Patients are offered the opportunity
1. Counsellor
2. Support groups
3. National support networks and Internet chat
rooms.
ABOUBAKR ELNASHAR

30.  ESHRE
 Support counseling should be
 part of any patient-centred care and TT
 focus specifically on
 the coping resources that patients have already
 developing new coping strategies
 HFEA
 Support counselling
 during the decision-making process and
 throughout treatment
 helping patients to make adjustments to their lives
ABOUBAKR ELNASHAR

31. 4. POST THERAPEUTIC COUNSELLING
 Essential for the couple to
 Cope with the results of treatment.
 Face any kind of problems even the failure of TT
 Involves
 development of coping strategies to
 minimise distress and
 maximise problem solving
 addressing specific issues such as
 sexual, marital and other potential
 interpersonal problems
 acceptance of their situation
 discussion about alternative lifestyles
ABOUBAKR ELNASHAR

32.  Psychological fertility-related questionnaires
 can be used with patients requiring therapeutic
counselling
 including inventories related to
 helplessness and acceptance,
 self-image,
 sexuality,
 infertility stress,
 motivation and irrational cognitions.
ABOUBAKR ELNASHAR

33. V. PROFESSIONAL QUALIFICATIONS AND TRAINING
(BICA, 2012)
 Different countries have their own
 guidelines
 regulation
 standards that infertility counsellors must achieve
 No international agreement of
 who can or should provide infertility counselling
services
ABOUBAKR ELNASHAR

34.  Qualifications
 HFEA’s 2012 states that practitioners must have
1. Diploma in
1. counselling,
2. clinical/ counselling psychology
2. Membership of
1. British Psychological Society or
2. British Association for Counselling &
Psychotherapy.
3. Should have or be working towards a specialist
Accreditation in infertility.
ABOUBAKR ELNASHAR

35.  Accreditation
 BICA
 offers specialist accreditation scheme
 developed a voluntary two-tier accreditation process
ABOUBAKR ELNASHAR

36.  Training
 BICA
 insists that at least 30 continuing professional
development hours per year
 offers many training courses
 conference participation, training opportunities
and international networking.
ABOUBAKR ELNASHAR

37.  Training includes:
 Medical aspects of infertility:
 basic reproductive physiology;
 diagnosis and treatment of infertility problems;
 aetiology of male and female infertility
 ART procedures.
 Psychosocial aspects of infertility
 marital and family issues
 impact on sexual functioning;
 various approaches to psychological assessment
 typical/atypical responses
 alternatives to family building including adoption,
surrogacy, and child-free lifestyle
 legal and ethical issues of infertility treatments.
ABOUBAKR ELNASHAR

38. CONCLUSION
 Infertility
 associated distress and wide-ranging
psychosocial implications.
 emotional impact is neglected and that the issue is
reduced to a biological or medical one.
 Infertility counselling
 occupies a unique and diverse position within the
infertility field
 combination of medicine and mental health
 medical and psychological aspects of infertility
treatment are integrated.
ABOUBAKR ELNASHAR

39.  The infertility counseller
 No international agreement of who can or should
provide infertility counselling services
 must remain within the boundaries of acceptable
practice as outlined by their professional body
 continuously engage in professional development,
 comply with the laws and standards of infertility.
ABOUBAKR ELNASHAR

40. Thanks
ABOUBAKR ELNASHAR